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an abnormal mass of tissue , with growth that exceeds and is uncoordinated with normal tissue . and persists in the same way even when stimulus has ceased . |
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Remains localized ,does not metastasize ,amenable to surgical removal,patient generally survives . |
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invasive and destructive growth Malignant tumors can invade and destroy adjacent structures and spread to distant sites (metastasize) to cause death |
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malformation comprising cells which demonstrate disorganised growth . any abnormal mixing of normal components of organs |
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Epithelial Neoplasms Cell types |
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Stratified Squamous ,glandular, Renal ,hepatocyte |
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Benign epithelial neoplasms |
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Squamous papiloma(stratified squamous ) Adenoma (glandular) Renal cell adenoma Hepatocellular adenoma |
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Malignant epithelial neoplams |
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Squamous cell carcinoma (stratified squamous) Adenocarcinoma Renal cell carcinoma Hepatocellular carcinoma |
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Mesenchymal neoplasms cell types |
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Smooth muscle ,skeletal muscle ,fat, cartilage ,blood vessels |
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Benign mesenchymal neoplasms |
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Leiomyoma(sooth muscle ) rhabdomyoma(skeletal muscle) Lipoma(fat) Chondroma(cartilage) Hemangioma (blood vessels) |
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Malignant mesenchymal neoplasms |
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leiomyosarcoma rhabdomyosarcoma chondrosarcma angiosarcoma |
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benign melanocytic neoplasm |
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nevus(birth mark or mole on skin ) |
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Malignant melanocytic neoplams |
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Benign germ cell neoplasm |
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malignant germ cell neoplasms (germ cell compnents) |
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malignant teratoma , seminoma/dysgerminoma, yolk sac tumour, embryonal carcinoma,choriocarcinoma |
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Site of embryonal neoplasms |
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kidney ,liver,eye,adrenal |
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Malignant embryonal neoplasms |
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nephroblastoma ,hepatoblastoma ,retinablastoma ,neuroblastoma |
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Behaviour of benign neoplasms (NSC) |
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1.non invasive and remains localised 2.slow growth rate 3.close histological resemblance to parent tissue |
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Clinical Features of benign neoplasms |
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pressure on adjacent tissue (meningioma-epilepsy) obstruction of the flow of fluid production of hormone (thyrotoxicosis) transformation into malignant neoplams (polyp to carcinoma) Anxiety |
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Behaviour of Malignant neoplasm |
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rapid growth rate-variable histo resemblence to parent tissue -poorly circumscribed- invasive growth- enroach on +destroy adjacent tissues-central necrosis-metastasis |
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Tumour implants discontinuous with primary tumour-marks tumour as malignant-metastasis |
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Pathways of metastasis(3) |
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Lymphatic ,haematogenous,transcoloemic |
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Lymphatic pathway of metastasis features |
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carcinoma ,lymph nodes become enlarged |
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Haematogenous pathway of metastasis features |
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Sarcomas,Carcinoma Sites(lung liver ,bone ,brain) |
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Transcoleomic pathway of metastasis features |
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Common sites(peritoneal,pleural +pericardial cavities) Results from effusion of fluid into cavity |
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Features of fluid found in transcoleomic metastasis |
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fluid rich in protein and may contain fibrin . fluid also contains neoplstic cells causing effusion |
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symptom in patients with malignant neoplams which cannot be explained by local growth or distant spread of the neoplasm or by elaboration of hormone indigenous to the tissue from which the tumour arose |
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Paraneoplstic effect features |
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may represent earliest manifestation of an occult neoplasm =-causes significant morbidity/mortality mimic metastatic disease and confound treatment |
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a change in defferentiated cells or tissues from one type to another that is not appropriate for that site |
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expansion of immature cells . |
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may indicate early neoplastic process, increased cell proliferation,presence of atypical morphology +decreased differentiation |
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dysplasia of the uterine cervix |
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caused by human papilloma virus graded by severity of dysplasia diagnosed by pap smear confirmed by biopsy |
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malignant epithelial tumour limited by basement membrane no access to lymphatics or blood and cannot metatsisize |
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Carcinoma in situ that has invaded thru the basement membrane . has access to lymphatics + blood vessels |
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process by which normal cells are transformed into neoplasmic/cancer cells genetic alterations are fundamental to carcinogenic process |
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accumulation of mutations leads to neoplastic transformation |
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environmental agent participating in the causation of tumours agents(carcinogenic/oncogenic-tumuor) |
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Main classes of carcinogens |
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Chemicals ,Microbes(viruses-HPV,bacteria-helicobacter,fungi-apergillus flavus,parasites) Radiation , Miscellaneous( exogenous hormones) |
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Chemical carcinogens features |
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act directly requiring no metabolic conversion,no common structural formulas to predict carcinogenic risk |
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oncogenic viruses Human PAPILLOMA VIRUS |
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Common Wart (squamous cell papilloma ) cevical carcinoma |
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oncogenic viruses Epstein Barr Virus |
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Burkitts lymphoma Nasopharyngeal cancer |
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Oncogenic viruses Hepatitis C+B Virus (requires co factor ) |
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Oncogenic viruses Human Herpes V8 |
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Kaposi Sarcoma (KS) Pleural effusion lymphoma Plasmablastic lymphoma |
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Oncogenic viruses Human T Cell lymphocytic Virus 1 |
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Adult T cell leukaemia /lymphoma |
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Helicobacter Pylori bacterial oncogenic characteristics |
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found in the stomach causes (gastritis,peptic ulceration,gastric lymphoma) |
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fungi oncogenic characteristics |
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myotoxins ,aflatoxins prod by aspergillus flavus =-linked to hepatocellular carcinoma in africa+China |
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Hepatocellular Carcinoma produced by ? |
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Aflatoxin (co factor ) + Hepatitis B |
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Schistosomiasis/bilharzia |
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parasitic disease caused by trematodes S. haematobium causes urinary schistosomiasis eventually cancer |
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liver flukes clonorchis+opisthorchis vivernini |
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implicated in adenocarcinoma of bile ducts (cholangiocarcinoma) |
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Uv light (skin cancer) Ionising Radiation(skin cancer ,leukemia0 minninf of radioactive uranium (lung cancer ) |
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skin cancer most common in parts exposed to light. more common in fair skinned increased risk for ( Albinos+XP-congenital deficiency of dna repair enzymes) |
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Ionising Radiation features |
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Carcinogenic effects are long term acute immediate dose-related effects(Skin erythema ,bone marrow aplasia) |
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miscellaneous carcinogens |
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hormones (exogenous oestrogen)-mammry +endometrial carcinomas Asbestos fibres -mesothelioma and carcinoma of the lung metals9nickel)-carcinoma of the mucosa linning the nasal cavities of the lung |
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Host factors of carcinogenesis |
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Race, Age ,Gender , Diet (LAck of protective factors ) inherited predisposition |
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Inherited predesposition of carcinogens |
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BRCA 1+2 on chromosomes 17+13=- breast cancer Abnormality of RB1on chromosome 13=--REtinoblastoma APC on chromosome 5=- increased risk of carcinoma of the colon |
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Intiation (genetic defect gives transformed cell neoplastic potential) Promotion(stimulation of colonal proliferation of initiated transformed cell) Progression (process culminating in malignant behaviour) |
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Genetic mechanisms in Carcinogenesis |
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Definition
1.Expression of teleorase to avoid replication senescence( deterioration with age) 2.inactivation of recessive tumour suppressor gene 3. enhanced expression of dominant oncogenes to self stimulate cellular replication |
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